| NPI | 1477555043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0061591) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 4928) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2021-02-24 |